Manchester triage system
The Manchester Triage System ( MTS ) is a standardized procedure for initial assessment in the emergency room . This is the first grouping of newly arriving patients in the emergency room. The aim is to quickly determine safe and comprehensible treatment priorities . In contrast to triage in cases of war or disaster, it is assumed that all arriving patients can actually be treated within a certain time window; a group of “dying people” that is not treated is therefore not provided. In the Anglo-American language area, the term “triage” is used for both approaches, while in German “triage” is used more for preclinical and disaster cases and “initial assessment” for routine clinical prioritization.
Starting with the first introductions in 1995 in Manchester, it soon found widespread use outside the British Isles. It is now used in Australia , Brazil , Germany , Ireland , Italy , Japan , Canada , Mexico , New Zealand , the Netherlands , Norway , Austria , Portugal , Sweden , Switzerland , Spain , and Tanzania .
In Germany , the introduction began in 2004 in the city clinics in Hamburg . The Charité was the first university clinic to introduce this procedure in 2008 , and it is now widely used throughout Germany in hospitals of all care levels and sponsorships. It can be assumed that around 20% of all emergency rooms in Germany use the MTS. In Austria , the MTS will be used in numerous hospitals at the Graz University Hospital from 2009. In Switzerland , the MTS has been established in the hospitals of Schaffhausen and the Triemli City Hospital in Zurich since the end of 2011 and is spreading rapidly, particularly in German-speaking Switzerland.
development
The Manchester Triage System was developed by the Manchester Triage Group (MTG). It was formed in 1994 from medical and nursing staff from the emergency services of the eight NHS hospitals in Manchester with the express aim of developing consensus among emergency physicians and nurses on the standards of clinical triage.
In 1994 hospitals across the UK had different schemes for setting treatment priorities. On the one hand, these were based on different characteristics , depended on the personal perception of the triage power and, on the other hand, had different time windows. The number of possible levels of classification also varied.
The realization of the need for a uniform scheme emerged against the background of establishing uniform and reliable standards of care. In addition, a quick and simple but meaningful should documentation be possible.
The MTG collected and compared the locally established schemes, then the similarities on the one hand and the differences on the other hand were worked out. On the basis of these findings, a discussion took place, at the end of which there was a consensus model for the initial assessment. The piloting took place in 1995 in Manchester, it was quickly followed by national distribution. The first international launches ( Ireland , Netherlands ) date back to 1996.
In 2005 the revised and expanded 2nd edition was published. It takes into account medical advances and the experience of the first ten years of use, but does not fundamentally change the system or the approach. With the appearance of the 2nd edition, an "International Reference Group" was established. Representatives of all national user groups work together in it and develop the system further by consensus. This form of collaboration is unique in the world and a unique selling point of the Manchester Triage System. Once a year a joint conference is held at different locations.
Procedure
The Manchester triage system is based on symptoms and key symptoms . Within a short time, the patient is assessed, for example, according to the symptoms of “mortal danger”, “ pain ”, “ blood loss ”, “ consciousness ”, “ temperature ” and “ duration of illness ” and assigned to one of five levels of urgency according to this assessment.
Maximum waiting times are assigned to these groups , i.e. the period of time after which a patient should have contact with a doctor at the latest. The groups are:
| group | designation | colour | Max. waiting period |
|---|---|---|---|
| 1 | IMMEDIATELY | red | 0 minutes |
| 2 | VERY URGENT | orange | 10 mins |
| 3 | URGENT | yellow | 30 minutes |
| 4th | NORMAL | green | 90 minutes |
| 5 | NOT URGENT | blue | 120 minutes |
To support the work of the first assessor , presentation diagrams were developed analogous to the typical symptoms , in which the possible symptoms (as so-called indicators) are assigned to the five urgency levels. These diagrams are labeled with terms that summarize the possible symptoms of the patient as meaningfully as possible. In addition to the expected diagrams such as “ asthma ”, “chest pain” or “wounds”, there are also those that may seem irritating at first glance, but aptly reflect everyday life in an emergency room: “crying baby” or “worried parents”.
Each diagram (symptom) and each indicator (symptom) is accompanied by explanations that should dispel doubts about the correct selection. For example, in the case of the special indicator “Unsuitable history” (used for example in the “Concerned Parents” diagram), the first assessor should be made aware of the possibility of abuse .
The implementation of the initial assessment is now supported by almost all large hospital information systems (HIS); this not only makes the initial assessment easier for the initial assessment, but also the documentation and subsequent evaluations.
See also
literature
- UB Crespin, G. Neff (Ed.): Handbook of sighting . Stumpf & Kossendey-Verlag, Edewecht 2000, ISBN 3-932750-20-9 .
- R. Kirchhoff (Ed.): Triage in the event of a disaster . primed-Fachbuch-Verlag, Erlangen 1984, ISBN 3-88429-115-7 .
- Kevin Mackway-Jones, Janet Marsden, Jill Windle (Eds.): Initial assessment in the emergency room. The Manchester Triage System. 3rd revised and supplemented edition, Huber, Bern 2011, ISBN 978-3-456-84986-7 (German-language edition translated, edited and edited by Jörg Krey and Heinzpeter Moecke).
Individual evidence
Web links
- ersteinschaetzung.de , German-language website of the national German reference group for the Manchester triage system from the publisher of the book First Assessment in the Emergency Room .